Pathologic Tumor Regression is Associated With Improved Survival in Pancreatic Cancer

Authors

Laura M. Nicolais, Division of Surgical Oncology, Tufts University School of Medicine-Maine Medical Center, Portland, ME, USA.
Molly Caron, Division of Surgical Oncology, Tufts University School of Medicine-Maine Medical Center, Portland, ME, USA.
Nicholas Verdini, Tufts University Clinical and Translational Science Graduate Program, Graduate School of Biomedical Sciences, Boston, MA, USA.
Timothy L. Fitzgerald, Division of Surgical Oncology, Tufts University School of Medicine-Maine Medical Center, Portland, ME, USA.

Document Type

Article

Publication Date

5-25-2023

Institution/Department

Surgery; Oncology

Journal Title

The American surgeon

Abstract

OBJECTIVES: The advent of effective chemotherapy regimens has increased the use of neoadjuvant multiagent chemotherapy in pancreatic cancer. However, the effect of tumor downstaging with neoadjuvant treatment on survival is unclear. METHODS: Retrospective study included all resected patients with pancreatic adenocarcinoma who underwent neoadjuvant chemotherapy with FOLFIRINOX or gemcitabine/Abraxane. Downstaging was quantified using (1) difference between presenting AJCC clinical and final pathologic stage and (2) College of American Pathologists (CAP) Tumor Regression Grading Schema. RESULTS: Eighty-seven patients met inclusion criteria. FOLFIRINOX was the most common regimen, 63.2% vs 21.8%. Change in regimen occurred in 15% of patients. Downstaging based on a difference in AJCC stage group occurred in only 4.6%. In contrast, 45.2% were classified as downstaged by the CAP Tumor Regression of 0-2. Downstaging was similar for FOLFIRINOX gemcitabine/Abraxane (64.7 vs 53.6, P = .12) using the CAP criteria. On univariate analysis, treatment regimen (gemcitabine/Abraxane vs FOLFIRINOX, median survival 27 vs 29 mo; HR 1.57, P = .2) had similar survival. Downstaging by the AJCC stage was not associated with improved survival (HR 1.51, P = .4). However, there was a survival benefit for those downstaged by the CAP Tumor Regression Grading Schema, the median survival of 41 mo vs 25 mo; HR 3.05, P = .009. Improved survival 3.32 (1.35-8.16), P = .009) was maintained on multivariate analysis. CONCLUSION: Survival is significantly improved in those downstaged, as assessed by the CAP Tumor Regression Schema. Downstaging is an important prognostic variable that can help with joint decision making for clinicians and patients.

Comments

Laura Nicolais- Resident

Molly Caron- Resident

First Page

31348231175120

Recommended Citation

Nicolais LM, Caron M, Verdini N, Fitzgerald TL. Pathologic Tumor Regression is Associated With Improved Survival in Pancreatic Cancer [published online ahead of print, 2023 May 25]. Am Surg. 2023;31348231175120. doi:10.1177/00031348231175120